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The reform of psychiatry in Germany has seen the conversion of numerous psychiatric hospitals into general hospitals with a psychiatric department. With regard to nursing care, a two-year additional training is offered to professionals wishing to work in psychiatry. Finally, there exists within the population a marginalisation of psychotic patients or of those suffering from an addiction.

While contemporary mental health services have been marked by the burgeoning of outpatient and preventive care, the historiography of psychiatry remains largely tied to the study of custodial and palliative treatment.The work in which contemporary psychiatry has been involved cannot be adequately understood as a singular, autonomous enterprise based in a residential facility. It has become a technoscience that operates in numerous settings and alongside multiple sciences, technologies and decision-makers. This paper explores what it might mean to 'deinstitutionalize' the history of contemporary psychiatry by examining the case of social therapy for sex offenders in West Germany.

Aim: This paper analyses, in what way psychiatrists considered housing and work as criteria of social integration of mentally ill people and what models of care were suggested in Germany throughout the 20th century., Method: Publications in 29 German professional and scientific psychiatric journals through the complete period from 1900 to 2000 and monographs were searched for papers on the above issues., Results: Until the second half of the century, integrative initiatives related to housing and work generated in asylums without the aim of a full social integration of the patients. In the activistic concept of NS-psychiatry, work became an obligation for patients and a criterion for selection that decided on life and death. Not until the late 1950s, there again was an orientation towards integration in psychiatric care in both German states. Whilst already in 1963 the "Rodewisch Theses" outlined recommendations for the rehabilitation of the mentally ill already in the GDR (East Germany), a similar mark of reform ideas was published in the "enquete" in the FRG (West Germany) in 1975. In the GDR initiatives were limited to a small number of locations. In the FRG and the re-unified Germany various forms of sheltered housing and work were established - also with significant regional variation. However, a clear discussion of underlying aims and implications for the structure of mental health care was not found in the psychiatric literature., Conclusions: In the 20th century a tradition of psychiatric ideas related to housing and work did not develop in Germany. Particularly, there were only sporadic contributions from university psychiatry. Work was more frequently explicit subject of discussions than housing. Both areas were - slowly and in discontinuity - established as criteria of integration of people with mental illnesses, which was increasingly accepted as an aim of mental health care.

This article is based on the thesis that family care in the 20th century was practiced mainly under pragmatical/economical and therapeutical aspects. Depending on time and place, one of the two aspects would dominate while the other would serve as supporting motive. The subject of this article is to examine selected models of family care in Germany at different times as to their aim regarding the social integration of psychiatric patients. The family care patients not only lived outside the psychiatric hospitals, but were usually employed in household, farming or trade of the foster home. So the integrative potential of family care was, and still is, aimed at establishing a living and working condition as "normal" as possible. Until 1945, patients who could not or were not allowed to return to a completely independent lifestyle, family care offered them the widest range of integration and freedom. The often observed long lasting stays in families, reflect this rise in quality of life, although many were formally still associated with the mental institution. Up to the fifties, family care can be evaluated as an attempt of psychiatric hospitals to encounter the social isolation of the mentally ill. Nowadays family care is seeing a certain renaissance as part of social psychiatry. It is however not always clear whether family care can serve as a mean of real integration in the sense of a completely independent living and working condition, or whether it leads only to an, even if permanent, extramural accommodation of the chronically ill patients.

In Germany, the concept of community-based care with the aim of a far-reaching integration of mentally ill and disabled into society was already established by W. Griesinger in the last century. He proposed asylums, located in the cities and linked to general hospitals, for short-term treatment of the acute mentally ill. He pointed out that a short-term inpatient stay can only be achieved when hospital and natural support systems cooperate closely. He never assumed that all kinds of mental illnesses can be cured, but thought that most inpatients could be discharged from hospital even though some would be in need of sheltered living conditions. Today, W. Griesinger's proposals are accepted worldwide. In 1975, a German expert commission submitted a report utilizing Griesinger's ideas as indispensable components of a modern psychiatric care system.

Outpatient psychiatric care linked to a hospital or institution is as old as psychiatry defining itself as a science. During the time of the Liberal Movement in Germany and the various revolutions that took place in several European countries (including Austria and various German states) in 1848, people were full of ideas and sociorevolutionary projects. It was then that they became conscious of the need to meet mentally ill persons in their own environment in order to help them in an adequate manner. Griesinger described in great detail such work as envisaged by him for his projected "municipal asylum" or "city asylum". However, all efforts in this direction were quashed in 1868 by a majority decision on the part of psychiatrics in favour of large-scale lunatic asyluma located far away from the densely populated areas. At the turn of the century, social awareness again began to grow; the asylums were overcrowded; and costs had risen tremendously. This resulted in building up a non-institutionalised "open service and care" for the insane. On the one hand, it was an outpatient care system in close co-operation with the asylum, i.e. the patients were looked up in their homes (Erlangen Model), whereas in several big cities the community Public Health Office was responsible for such psychiatric care (Gelsenkirchen Model). In the German Republic that existed from 1919 to 1933, "open" psychiatric care was extended, and the psychiatrist who advocated it were gradually drawn into a maelstrom of a sociodarwinistic type of racialism.(ABSTRACT TRUNCATED AT 250 WORDS)